About the job
Title: HEDIS Nurse
Client: Large health insurance company
Length: January 5, 2026 – May 15th, 2026
Location: Remote
HEDIS RNs:
RESPONSIBILITIES/TASKS:
- Perform HEDIS® medical record review, abstraction, IRR, quality assurance over-reads, and other MRR support as assigned.
- Meet day-to-day production and quality goals and maintain 95%+ quality accuracy.
- Perform multiple medical record review projects.
- Maintains a comprehensive understanding and knowledge of HEDIS® measures and requirements.
- Applying core clinical concepts applicable to chart review and measure interpretation.
- Reviewing the more complex measures.
- Completes ad-hoc data requests as assigned.
- Ensures complete, accurate and timely production of MRR activities.
- Recommends and assists with implementing solutions to identified problems/root cause of issues.
- Provides expertise and guidance to staff as required.
- Represents and participates in group or committee discussions.
EMPLOYMENT QUALIFICATIONS:
EDUCATION:
Registered Nurse and minimum of 3 years (seasons) of medical record auditing and HEDIS experience. Certification or progress toward certification is highly preferred and encouraged.
Licensed Practical Nurse (LPN) with 5+ years of HEDIS® and clinical experience along with 2+ years of HEDIS® supervisory experience may be considered in lieu of Registered Nurse licensure.
EXPERIENCE:
- Three (3) years of experience in HEDIS® is required to provide the necessary knowledge, skills, and abilities for the role.
- Minimum of three (3) years of experience with NCQA HEDIS® hybrid measure abstraction including overreads/QA.
- Advanced knowledge of HEDIS and NCQA.